To change satisfaction go beyond measurements
Here's how to turn data into solid results
Pretty line graphs and bar charts are no answer to the complaints of patients who stay awake all night listening to the clatter of computer printers down the hall. The solution happens when you turn it over to someone "with a passion for the data," explains Dewayne Belew, director of Marketing and Public Relations at Bradley Memorial Hospital in Cleveland, TN. The answers are there waiting to evolve into action messages for people with the power and willingness to make changes. QI/TQM talked to professionals in two facilities who plowed into existing patient feedback data, and without fancy preliminaries, turned out remarkable improvements.
Moral of closed doors: Easy way is best
Bradley Memorial's quality assessment resource assistant Brenda Wynkoop, CUR, breathes life into the hospital's Press, Ganey Associates (based in South Bend, IN) patient feedback. When she came on board just over a year ago, she noted a per-quarter average of 35 to 40 complaints regarding the late-night clatter of printers churning out the day's lab reports. Situated next door to patient rooms, the printers made so much noise that patients couldn't sleep. "We had data from 1993, but nobody knew what to do with it," says Wynkoop.
"Now we look at each aspect of patient feedback data," she continues. She takes pertinent findings to each nursing unit's staff meetings and involves staff in devising solutions. With the loud computer printers, for instance, the night staff said they heard the racket themselves so they knew exactly what was bugging the patients. With Wynkoop's encouragement, they found a solution in one meeting.
"At first people went for the big answer" such as moving the computers or buying $500 to $600 plexiglass covers for the machines, she says. They considered carpeting to mute the noise. Then someone said "why don't we shut the patients' doors?" That was the answer; case closed.
Though not all complaints come to swift and simple ends, Belew cites attentiveness to each detail as the key to unraveling more complex solutions.
A case in point is the effort to reduce wait time at Bradley Memorial's emergency department (ED). The first 12-month phase went without a hitch. But when data collection was completed and new admission strategies were ready to launch, attendance at performance improvement team (PIT) crew meetings flagged.
Wynkoop's investigation indicated it was time to revise PIT crew membership teams to involve people with the power to act during the implementation phase. "When they made that shift," Belew observes, "they could roll again." And, in fact, within four months of the change, the average registration-to-discharge time in the ED plunged 60%, from about three hours to about two hours. (For more information, see PIT crew overview, inserted in this issue.)
TLC for breast surgery patients wins kudos
In an unusual turnabout, physicians initiated a QI project at Fletcher Allen Health Care in Burlington, VT. Concerned about the high levels of anxiety in women who came in for breast biopsies and mastectomies, the surgeons and radiologists asked for help from the nurses at the medical center's Breast Care Center.
To get a better understanding of the issue, the center's administrative leader, Jean Harry, RN, began immediately to decode the previous year's patient satisfaction surveys. She learned that the women wanted three service augmentations:
1. Preview of what to expect on the pre-biopsy visit with the surgeon and oncology nurses.
2. Instructions on preparation for outpatient biopsy and estimates of how long it could take.
3. Post-biopsy provider calls to ask how they were feeling and answer any questions about post-surgical self-care.
Harry says it only took four to six weeks for her and her staff to analyze the patient survey data and create a patient education tool. And the results were immediate. "We got feedback from the physicians doing the biopsies," Harry reports. "They were telling us the procedures went much smoother." Also, prepared with background from the Breast Care Center, patients make such efficient use of their pre-biopsy visits with the surgeons that they require 30 minutes less time than before the educational program.
In the wake of the initial successes enjoyed from the patient education project, the center engineered an additional improvement for women facing inpatient breast surgeries. They regularly endured 90-minute waits for their pre-op lab work and X-rays at the medical center's outpatient department. "So why not take care of that under our own roof since the women would be coming here for pre-op education?" asked Harry and her staff. Pilot tests confirmed that consolidating lab tests and X-rays with the pre-op education was a good idea. Now it's routine practice. "It saves the patients a lot of time and an extra trip before they go in for surgery," Harry says. "They love it!"
Fine line between sound practice and change
Despite positive physician and patient response, Harry treads gingerly along political and disciplinary lines. When she wrote the protocol for the post-biopsy phone check in, she specified that nurses would confine their discussions to pain management, wound care, and emotional concerns.
"We didn't want to want to cross the political line of telling patients whether their lab tests were all clear or whether they had malignancies. We left that to the doctors because we did not want to appear to be taking over with their patients."
Recently, Harry had to revisit the matter when primary care physicians themselves asked the nurses to go ahead and tell women their lab test results on the biopsied breast tissue. It could have been an easy way to spare the patients and doctors a fair amount of hassle. Still she declined. This time it was on patient care principles.
Concerned that a nurse might not know what follow-up an individual doctor would choose in light of a patient's overall health history, Harry though it would be better to leave that segment of care in physicians' hands. However, the nurses nudge doctors who delay in conveying biopsy results. She adds, "If a woman tells us her doctor hasn't called after a few days, we will call that doctor and say, 'Look, you need to call this patient.'"
[For more information, contact:
· Dewayne Belew, Bradley Memorial Hospital, P.O. Box 3060, Cleveland, TN 37320-3060. Telephone: (423) 559-6116. Fax: (423) 559-6800. E-mail: [email protected]. Or Brenda Wynkoop, Telephone: (423) 559-6085. Fax: (423) 559-6656.
· Jean Harry, Fletcher Allen Health Care, Breast Care Center, UHC Campus, 1 South Prospect St., Burlington, VT 05401-3456. Telephone: (802) 656-8820. Fax: (802) 656-3464. E-mail: [email protected].]
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